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Success Factors of Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal & Ureteric Calculi in Adult  [PDF]
Ammar Fadil Abid
Open Journal of Urology (OJU) , 2014, DOI: 10.4236/oju.2014.43005

The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi; Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.

Khalid M. Saeed
The Professional Medical Journal , 1998,
Abstract: One hundred patients of both sexes between the age of 18-50 years suffering from radio opaque renal stones(1.5-2.5 cm) with functioning kidney were included in the study.The patients were randomly divided into two groups, Group-I (50 patients of kidney stones who were treatedwith ESWL, with 6 Fr. double-j-stent) and Group-II (50 patients who had ESWL, without double-j-stent).Patients were followed-up till they became stone free. There was no statistical significant difference in theclearance time (3.4 and 3.5 months) and clearance rate (68.75% and 72.91%) after three months in stentedand control groups respectively. The complications like bladder discomfort, renal pain pyuria. bactiuria weresignificant in the stented group, while microscopic haematuria was observed in all patients in both groups.Persistent pyrexia was observed in 14.3% patients in stented group, however, it was transient and subsidedwithout any medication in non-stented group. The mean hospital stay was 5.6 and 3.7 days in Group-I andGroup-11 respectively. Steinstrasse was observed in 12% and 16% in stented and non-stent groups. Fivepatients (10%) of non-stented group required auxiliary procedures. Mean stone size in these patients was2.2 cm. Auxiliary procedure was not required in Group-1. It is concluded that patients with 2 cm stones ormore are suitable for double-j-stenting before ESWL.
Factors affecting urinary calculi treatment by extracorporeal shock wave lithotripsy  [cached]
Tarawneh Emad,Awad Zeyad,Hani Audy,Haroun Azmi
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Extracorporeal Shock Wave Lithotripsy (ESWL) is still the treatment of choice for most renal and upper ureteric stones; however the outcome depends on multiple factors. The objective of this study was to investigate the effects of stone density, as measured by Hounsfield Units (H.U) by non-contrast Computerized Tomography (CT), stone size and stone location on ESWL treatment outcome of urinary calculi in Jordanian patients. 65 patients underwent clinical, biochemical and radiological assessments followed by ESWL treatment. Statistical analyses including chi-square, analysis of variance (ANOVA), correlation, regression were performed for statistical significance between ESWL treatment, stone fragmentation and stone density, size and location in the renal pelvis. ESWL success rate was high (94%) for low density stones (< 500 Hounsfield units). In general CT densities of 750 Hounsfield units or less were almost always successfully treated by ESWL. An inverse association between ESWL treatment outcome and stone size was also documented. CT stone density and stone size combined account for nearly 73% of the variation in the number of shock waves required to attain fragmentation. Stones located in lower calyceal area had less success rates. In conclusion, stones with higher density, large size and lower location may better be managed by percutaneous nephrolithotomy.
Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants  [PDF]
Mehdi Younesi Rostami,Mehrdad Taghipour-Gorgikolai,Rayka Sharifian
Advances in Urology , 2012, DOI: 10.1155/2012/589038
Abstract: Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6?mm to 22?mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13?mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13?mm. 1. Introduction For a long period of time, stone treatment in some patients has been a matter of controversy for urologists. Complex stones were traditionally removed by surgical intervention [1]. However, the surgical management of urolithiasis has now largely been replaced with a minimal invasive procedure-like extracorporeal shock wave lithotripsy (ESWL) [2]. The introduction of ESWL in 1980 revolutionized urolithiasis treatment [3], and now it is accepted as a highly efficacious treatment modality for most renal calculi in the pediatric population [4]. Preoperative and long-term follow-up in the pediatric population treated with ESWL suggest is minimal deleterious effects on functional measures, overall growth, and development of kidneys [5, 6]. Perhaps the good results are due to the better shock wave transmission through the smaller body volume in infants in comparison with that of the adults [7]. Although evidence has accumulated on the efficacy of ESWL in treating calculi in infants [8–10], the effect of shock wave on the pediatric urinary tract still needs to be clarified. In this study we evaluated the efficacy of ESWL in infants with renal stones, with regard to the ability of ureters to transport the fragments and the need for adjunctive procedures such as
Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction
Ghalayini, Ibrahim F.;Al-Ghazo, Mohammed A.;Khader, Yousef S.;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000600006
Abstract: objective: we compared the efficacy of extracorporeal shock wave lithotripsy (eswl) and ureteroscopy (urs) for the treatment of distal ureteral calculi with respect to patient satisfaction. materials and mhetods: this is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with eswl (n = 92) using dornier lithotriptor s (medtech europe gmbh) or urs (n = 120). patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. results: the 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. the stone-free status for eswl and urs at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). in addition, 88% of patients who underwent eswl versus 20% who underwent urs were discharged home the day of procedure. minor complications occurred in 3.3% and 8.3% of the eswl and urs groups, respectively (p = 0.127). no ureteral perforation or stricture occurred in the urs group. postoperative flank pain and dysuria were more severe in the urs than eswl group, although the differences were not statistically significant (p = 0.16). patient satisfaction was high for both groups, including 94% for urs and 80% for eswl (p = 0.002). conclusions: urs is more effective than eswl for the treatment of distal ureteral calculi. eswl was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. patient satisfaction was significantly higher for urs according to the questionnaire used in this study.
African Journal of Urology , 2002,
Abstract: Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter. The stone burden ranged from 6 14.8 mm (mean 11 mm). ESWL was performed under intravenous sedation or general anaesthesia on an outpatient basis. Results The stones were located in the upper ureter in 11 cases, in the mid ureter in 2 cases and in the lower ureter in 7 cases. At 3 months, a successful outcome (stone-free status) had been achieved in 18 cases (90%). The success rates related to the different levels of the ureter were 91%, 100% and 85.7% for the upper, mid and lower ureter, respectively. Four cases (22.2%) needed re-treatment to be stone-free. Pre-ESWL double-J stenting was required in 10% of the cases. The postoperative period was uneventful. None of the patients had post-treatment ureteral obstruction or urinary infection. Mild post-operative complications were encountered in the form of mild transient haematuria in all and colics in 8 patients. Conclusion In the paediatric age group, in-situ ESWL may be an effective modality for treating ureteric calculi at all levels of the ureter. It has no procedure-related morbidity. Calculs Urétéraux Chez lEnfant: Lithotripsie Extra-Corporelle In Situ Objectif Cette étude avait pour but lévaluation prospective de lefficacité de la lithotripsie extra-corporelle in situ dans le traitement des calculs urétéraux chez lenfant. Patients et Méthodes Vingt deux enfants agés de 2,2 à 16 ans, avec 22 calculs urétéraux, ont été traités par lithotripsie extracorporelle utilisant un lithotripteur Dornier S. La taille du calcul variait de 6 à 14,8 mm (moyenne 11 mm). La lithotripsie a été réalisée sous sédation intraveineuse ou anesthésie générale en ambulatoire. Résultats Le calcul était situé dans la portion haute de luretère dans 11 cas, dans la portion moyenne dans 2 cas et dans la partie basse dans 7 cas. A 3 mois, un succès (absence totale de calcul) a été obtenu dans 18 cas (90%). Les taux respectifs de succès selon les sièges du calcul, de haut en bas, étaient de 91%, 100% et 85,7%. Un traitement complémentaire a été nécessaire dans 4 cas (22,2%). La montée dune sonde double J avant la lithotripsie a été nécessaire dans 10% des cas. Les suites étaient simples. Il navait ni obstruction urétérale ni infection urinaire. De légères hématuries et coliques transitoires ont été observées après la lithotripsie. Conclusion Chez lenfant, la lithotripsie extra-corporelle in situ est une procédure efficace dans le traitement des calculs urétéraux quelque soit le siège. Il ny a aucune morbidité liée à la procédure. African Journal of Urology Vol.8(1) 2002: 13-19
Ureteroscopic and Extracorporeal Shock Wave Lithotripsy for Rather Large Renal Pelvis Calculi
Kamyar Tavakkoli Tabasi,Mehri Baghban Haghighi
Urology Journal , 2007,
Abstract: Introduction: The aim of this study was to compare the results and complications of extracorporeal shock wave lithotripsy (SWL) plus retrograde ureteroscopic lithotripsy using laser and pneumatic lithotriptors with SWL monotherapy for renal pelvic calculi between 2 cm and 3 cm. Materials and Methods: A total of 55 patients with 2- to 3-cm pelvic calculi were assigned into groups 1 and 2, including 22 and 33 patients, respectively. Patients in group 1 first underwent laser pneumatic lithotripsy and insertion of a double-J ureteral catheter and then underwent SWL 2 to 4 weeks thereafter. In group 2, the patients underwent SWL after double-J ureteral catheter insertion. The stone-free rate, complications, and cost effectiveness were evaluated 3 months postoperatively. Results: Five patients (22.7%) in group 1, had their calculi completely fragmented after ureteroscopy and retrograde lithotripsy without any need for further SWL. In 9 patients (40.9%), after a single session of SWL, and in 3 (13.6%), after 2 sessions, fragmentation was completed. In group 2, successful treatment was achieved after 1 and 2 SWL sessions in 6 (18.2%) and 8 (24.2%) patients, respectively. The stone-free rate was significantly higher in the patients of group1 than those in group 2 (77.3% versus 42.4%, respectively; P = .01). The period of anesthesia was 23.1 minutes (during ureteroscopy) in group 1 and 13.2 minutes in group 2 (during cystoscopy or ureteroscopy and insertion of ureteral catheter). No significant complication was reported in neither of the groups. The mean costs of the treatment were US $ 400 and US $ 370 in groups 1 and 2, respectively. Conclusion: Ureteroscopic lithotripsy before SWL is a rational method for the treatment of the rather large renal pelvic calculi with fairly acceptable costs.
Solo Extracorporeal Shock Wave Lithotripsy for Management of Upper Ureteral Calculi With Hydronephrosis
Sushant Wadhera,Rajkumar K Mathur,Sudershan Odiya,Ram Sharan Raikwar
Urology Journal , 2008,
Abstract: Introduction: The aim of this study was to evaluate extracorporeal shock wave lithotripsy (SWL) outcomes as a solo therapy in patients with upper ureteral calculi and varying degrees of hydronephrosis. Materials and Methods: Eighty patients with upper ureteral calculi and a body mass index between 19.5 kg/m2 and 22.5 kg/m2 were included. They were categorized into 4 groups according to the severity of hydronephrosis as seen on ultrasonography and intravenous urography: group 1, no dilatation; group 2, mild dilatation; group 3, moderate dilatation; and group 4, severe dilatation of the pyelocaliceal system. The size of calculi, time to calculus clearance, success rate of solo SWL, and the need for additional therapeutic methods were recorded and compared between the four groups of patients. Results: The median size of the calculi was 13.5 mm, and the mean time to calculus clearance was 56.0 ± 24.2 days. In 71.3% of the patients, solo SWL was successful in the treatment of the calculi. Twenty-three patients required other therapies including double-J stenting, ureteroscopy, and nephrolithotomy. The patients without hydronephrosis and those with severe hydronephrosis (groups 1 and 4) showed a significant difference in the days to clearance of the calculus (mean, 31.7 days versus 85.6 days; P < .001). Conclusion: Patients with upper ureteral calculi and mild hydronephrosis can be effectively treated with solo SWL therapy. In those with moderate hydronephrosis, clearance takes longer or requires secondary interventions. In patients with severe hydronephrosis, we recommend alternative/adjunctive procedures.
Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision
Kogenta Nakamura, Motoi Tobiume, Masahiro Narushima, Takahiko Yoshizawa, Genya Nishikawa, Yoshiharu Kato, Remi Katsuda, Kenji Zennami, Shigeyuki Aoki, Yoshiaki Yamada, Nobuaki Honda, Makoto Sumitomo
BMC Urology , 2011, DOI: 10.1186/1471-2490-11-26
Abstract: The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment.At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each.ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.Extracorporeal shock wave lithotripsy (ESWL) was introduced in clinical practice by Chaussy et al. in the 1980 s [1]. Its usefulness is widely recognized, and it has become the most common treatment for upper urinary tract stones. ESWL has been performed more frequently than TUL for stone treatment in Japan compared with that in Europe and the United States (2008 General Meeting, Seminar of the Japanese Urological Association), which may be largely attributable to its simplicity and/or the National Health Insuranc
Transureteral Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Management of Upper Ureteral Calculi: A Comparative Study  [cached]
Mohammad Reza Nikoobakht,Ala Emamzadeh,Amir Reza Abedi,Kamran Moradi
Urology Journal , 2007,
Abstract: Introduction: Our aim was to compare transureteral lithotripsy (TUL) and extracorporeal shock wave lithotripsy (SWL) in the management of upper ureteral calculi larger than 5 mm in diameter. Materials and Methods: Patients who had upper ureteral calculi greater than 5 mm in diameter were enrolled in this clinical trial. The calculi had not responded to conservative or symptomatic therapy. Semirigid ureteroscopy and pneumatic lithotripsy were used for TUL in 52 patients and SWL was performed in 48. Analysis of the calculi compositions was done and the patients were followed up by plain abdominal radiography and ultrasonography 3 month postoperatively. Results: The stone-free rates were 76.9% in the patients of the TUL group and 68.8% in the patients of the SWL group. These rates in the patients with mild or no hydronephrosis were 85.7% and 59.1% for the SWL and TUL groups, respectively. In the TUL group, half of the patients with no hydronephrosis developed upward calculus migration. The stone-free rates were 75.0% and 89.3% for the patients with moderate hydronephrosis and 70.0% and 100.0% for those with severe hydronephrosis in the SWL and TUL groups, respectively. All of the failed cases were treated by double-J stenting and TUL or SWL successfully. There were no serious complications. Upward calculus migration after TUL was more frequent in cases with no hydronephrosis or mild hydronephrosis (41.0%). Conclusion: Upper ureteral calculi smaller than 1 cm can be safely and effectively managed using semirigid ureteroscopy and pneumatic lithotripsy. However, the SWL approach has still its role if an experienced endourologist is not available.
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